A prospective randomized, double-blind, controlled clinical trial to compare the clinical efficacy and side effects of intravaginal misoprostol with the traditional prostaglandin, gemeprost, in second-trimester pregnancy interruption was conducted. A sample size of 100 women was calculated to demonstrate that misoprostol was as effective as gemeprost in achieving delivery within 24 hours (alpha = 0.1, 80% power). Women were recruited with fetal death in utero, severe fetal anomaly, or psychosocial pregnancy termination between 14 and 28 weeks gestation and randomized to receive either 1 mg gemeprost 3 hourly for 5 doses, or 200 mcg misoprostol 6 hourly for 4 doses, intravaginally. The therapeutic regimens were repeated if undelivered by 24 hours. Those undelivered after 48 hours received an extra-amniotic PGF2 alpha infusion. The median gestation at recruitment was identical: gemeprost 19 weeks (IQ 17-22 weeks) vs. misoprostol 19 weeks (IQ 17-21 weeks), P = 0.887. Delivery within 24 hours occurred in 75.1% of women receiving gemeprost and 74.9% receiving misoprostol (P = 1.0). The median time from prostaglandin commencement to delivery was similar: gemeprost 13.7 hours (IQ 9.0-23.5 hours) vs. misoprostol 16.9 hours (IQ 10.3-23.5 hours), P = 0.769. A significant reduction in the incidence of vomiting in women randomized to misoprostol occurred (34% vs. 13.2%, P = 0.017). There was no significant difference in the incidence of maternal fever > 37.5 degrees C, nausea, diarrhea, or placental retention. A 200-fold pharmaceutical cost advantage was observed with the use of misoprostol compared with gemeprost. Intravaginal misoprostol performs as effectively as gemeprost in achieving delivery in the second trimester without increase in adverse effects and displaying a significant cost advantage.

Abortifacient Agents, Nonsteroidal↗

PubMedDate not supplied

Maternal, but not fetal, administration of corticosteroids restricts fetal growth.

OBJECTIVE: Previous studies have shown that repeated doses of corticosteroids given to pregnant sheep improve postnatal lung function, but restrict fetal growth. Repeated administration of corticosteroids directly to the fetus also enhances postnatal lung function. The purpose of the present study was to investigate and characterize the relative effects on growth of repeated maternal and fetal treatments by study of body, organ, and placental weights. METHODS: Date-bred pregnant sheep were given intramuscular betamethasone or saline to either the mother or fetus on three occasions at weekly intervals commencing at 104 days gestation, followed by cesarean section at 125 days. Twenty-two animals which had received three doses of betamethasone were compared with 21 which had received a single dose at 104 days and with 12 saline-treated controls. RESULTS: Repeated maternal doses of betamethasone resulted in reductions in birthweight and weights of the placenta and major organs. Direct fetal injection did not affect birthweight, placental weight, placental/ birthweight ratio, or weights of the major organs with the exception of the liver. CONCLUSIONS: Administration of repeated doses of betamethasone directly to the sheep fetus does not produce the growth-restricting effects induced by maternal administration and does not affect the placental/birthweight ratio.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Functional interaction between human T-cell protein CD4 and the major histocompatibility complex HLA-DR antigen.

Mature T cells segregate phenotypically into one of two classes: those that express the surface glycoprotein CD4, and those that express the glycoprotein CD8. The CD4 molecule is expressed primarily on helper T cells whereas CD8 is found on cytotoxic and suppressor cells. A more stringent association exists, however, between these T-cell subsets and the major histocompatibility complex (MHC) gene products recognized by their T-cell receptors (TCRs). CD8+ lymphocytes interact with targets expressing class I MHC gene products, whereas CD4+ cells interact with class II MHC-bearing targets. To explain this association, it has been proposed that these 'accessory' molecules bind to monomorphic regions of the MHC proteins on the target cell, CD4 to class II and CD8 to class I products. This binding could hold the T cell and its target together, thus improving the probability of the formation of the trimolecular antigen: MHC: TCR complex. Because the TCR on CD4+ cells binds antigen in association with class II MHC, it has been difficult to design experiments to detect the association of CD4 with a class II molecule. To address this issue, we devised a xenogeneic system in which human CD4 complementary DNA was transfected into the murine CD4-, CD8- T-cell hybridoma 3DT-52.5.8, the TCR of which recognizes the murine class I molecule H-2Dd. The murine H-2Dd-bearing target cell line, P815, was cotransfected with human class II HLA-DR alpha, beta and invariant chain cDNAs. Co-culture of the parental T-cell and P815 lines, or of one parental and one transfected line resulted in a low baseline response. In contrast, a substantial increase in response was observed when CD4+ 3DT-52.5.8 cells were co-cultured with HLA-DR+ P815 cells. This result strongly indicates that CD4:HLA-DR binding occurs in this system and that this interaction augments T-cell activation.

Animals↗

PubMedDate not supplied

Prenatal diagnosis in congenital contractural arachnodactyly.

Congenital contractural arachnodactyly (CCA) is a heritable connective tissue disorder caused by defects in the gene encoding fibrillin-2 (FBN2). People with CCA typically have a marfanoid habitus, flexion contractures, severe kyphoscoliosis, abnormal pinnae, and muscular hypoplasia. Because of the relative infrequency of the syndrome and its generally mild to moderate severity, prenatal diagnosis had not previously been sought. Here we report prenatal diagnosis in a family with CCA. Because the course of the disease in the proband was rather severe, she had requested genetic counseling as early as age 17. She delayed childbearing until prenatal diagnosis for CCA became possible. This decision was supported by her mother and later her husband. Because she shared the same genotype with her husband, genetic linkage analysis of this family did not alter the a priori 50% risk of having an affected child. The possibility of unambiguously ascertaining the affected status of a fetus homozygous for the tested FBN2 marker was sufficient for the family to pursue prenatal diagnosis. This case strongly points to the importance of informed decisions now that genetic testing is becoming commonplace.

Adult↗

PubMedDate not supplied

Making quality and service pay: Part 2, The external environment.

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Humans↗

PubMedDate not supplied

The real problem.

I really was dismayed to see the basic cause of all our planet's problems buried in the September/October 96 issue: "...religious zealots might wreck the family planning needs of a billion people...." Let's face hard facts: all these problems would go away if the planet's population were small enough. What we really need to establish is what the population of the earth should be, and then set out to achieve that population as soon as possible. All of our efforts to reduce automobile pollution, the amount of reactor waste, the number of species being obliterated, etc., are just postponing the inevitable. What we need to look at, and keep track of, are those factors that encourage expanding population and discourage population control. For example, most businesses like to see the population expand so they can have a growing customer base. I truly appreciate your efforts. But if we are going to get anywhere we have to clearly identify the real problem. And then we have to break it down into manageable pieces and go to work on them. Otherwise we are going to keep looking at the graphs and wringing our hands as this accumulation of problems builds until it sweeps over us like a giant tsunami.

Conservation of Natural Resources↗

PubMedDate not supplied

Approaching death.

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Anxiety↗